Aim-The aim of this study was to explore the influence of unit characteristics, staff characteristics and teamwork on job satisfaction with current position and occupation.Background-Teamwork has been associated with a higher level of job satisfaction but few studies have focused on the acute care inpatient hospital nursing team.
Background Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes. Objectives To determine the association between nurse staffing, nurse work environments, and IHCA survival. Research Design Cross-sectional study of data from: (1) the American Heart Association’s Get With The Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and and Patient Safety; and (3) the American Hospital Association annual survey. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge after adjusting for hospital and patient characteristics. Subjects A total of 11,160 adult patients aged 18 and older between 2005 and 2007 in 75 hospitals in 4 states (Pennsylvania, Florida, California, and New Jersey). Results Each additional patient per nurse on medical-surgical units was associated with a 5% lower likelihood of surviving IHCA to discharge (odds ratio = 0.95; 95% confidence interval, 0.91–0.99). Further, patients cared for in hospitals with poor work environments had a 16% lower likelihood of IHCA survival (odds ratio = 0.84; 95% confidence interval, 0.71–0.99) than patients cared for in hospitals with better work environments. Conclusions Better work environments and decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an IHCA. These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments. Improving nurse working conditions holds promise for improving survival following IHCA.
Background Researchers frequently use nurse staffing measures to examine hospital quality of care. Measure choices include nurse-reported perception of staffing adequacy, nurse-reported patient workloads, and empirically-derived hours per patient day (HPPD). Objective To examine the correlations across these measures and identify factors associated with these staffing measures. Design, Settings, and Subjects A cross-sectional correlational study of 92 medical-surgical, rehabilitation, and intermediate in 11 acute care hospitals. Methods We surveyed registered nurses on their perceived staffing adequacy, last shift patient workload, and unit-level structures and processes of care delivery. Individual responses to these measures were aggregated to the nursing unit level, and unit-level HPPD, unit-level case mix index (CMI) were obtained from each hospital’s administrative data. After examining the correlation matrix across variables, those associated with the three staffing measures were then examined using linear regression. Results HPPD and the nurse-reported patient workload on last shift were correlated (r=−.276, p=.008), and perceptions of the adequacy of staffing and nurse-reported patient workload on last shift were correlated (r=−.384, p=.000). In multivariable analyses, inadequate numbers of assistive personnel was significantly associated with both perceived staffing adequacy and nurse-reported patient loads. Unit-level CMI was significantly associated with both HPPD and nurse-reported patient loads. These data suggest that the three measures of nurse staffing are not highly correlated, and may capture different elements of the unit context to explain nurse staffing. Researchers should consider the correlates of these measures when selecting nurse staffing measures for future investigations.
This project was an initial attempt to help nonnurses who will potentially work in the health care field to gain an understanding of the impact of distractions and interruptions on nurses. Graduate students in the Institute for Health Care Improvement Open School participated in an unfolding simulation in a hospital setting to expose them to the challenges of providing care in a work environment that often includes multiple interruptions.
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